Today would have been the 40 week mark, and original due date for Parks and Wyatt. From here on out we are dealing with their two ages, their actual ages and their adjusted ages. Their actual ages are 6 weeks, 4 days, and their adjusted age is 1 day. We took Wyatt to the pediatrician today in order to do something about the reflux. She gave us some Zantac, and hopefully it will do the trick. He also got weighed today and is 5 pounds. Parks also recently got weighed and is 8 pounds. Speaking with the adjusted ages in mind, these are not bad weights. Furthermore, Wyatt is taking in 65 mL per feeding, and Parks is taking roughly 110 mL per feed. We looked up both their recommended feeding amounts for their ages and weights, and the guidelines are saying 49 mL and 79 mL, respectively. Hopefully, they will keep excelling and catch up to the normal growth curve sooner than we thought.
Saturday, June 30, 2007
Thursday, June 28, 2007
Well...actually two quick notes.
The last two nights have been pretty wild. We have them both on 3 hour feeds to limit the fasting time for Wyatt with his blood sugar issues. He has really been having a tough time getting adjusted to his new surroundings, which means that we have had a tough time getting adjusted. He has been sleeping very little through the night in between feeds. Randi is still taking the full brunt of it, since I can still sleep through most anything. It seems impossible right now that Randi can feed and burp both of them by herself. Randi's mom is here this week, which allows me to get some work done during the day, albeit working half-asleep. It is going to take some time to get into a workable routine and get to know Wyatt's needs. We believe he has reflux, which lends to an expressive amount of uncomfortability for him. We are so thankful that Parks was able to come home early and get all this out of the way prior to Wyatt. Parks is a trooper and is in a great routine now. We are hoping that is will be only a short adjustment period.
As for the second note, I wanted to answer some questions about the dogs. Dante is the only one here now, which is another blessing. He is so docile and, generally, could cares less about these newest intruders to his home. He has been a little more needy over the past couple of months as though starved of attention. Rawhides and knuckle bones have lost all taste for him. Duke is still on summer vacation on the dog show circuit. He is spending most of his days running the fields along coastal Georgia with the breeder and their brood of other dogs. I think I miss him more than Randi, but we are not expecting to get him back until August or September. He will be appearing in a fews shows around the Atlanta area in August, and we are hoping to make a dual purpose trip up there to see him in action and attend a baby shower for a friend of ours.
Wednesday, June 27, 2007
Tuesday, June 26, 2007
The Day Has Come. We have been waiting for a long time to have both of ours sons at home. This Saturday will be the 40 week, full term for both of them. It has been six weeks today that Randi delivered Wyatt and Parks. Well, I am happy to say that I am sitting on the sofa at our house with little Samuel Wyatt on my chest and using Randi's nursing pillow to prop up the laptop to write this post. Emerson Parks is fast asleep in the crib, and Dante is collapsing into a nervous sleep from all the new sights and sounds of two needy, young babies in the house.
A Series Of Fortunate Events. We have been trying to find sustainable, albeit not permanent, solutions to Wyatt's blood sugar roller coaster. We finally found a mix of several medications, including iron supplements, a steroid, and an insulin suppressant, all with different dosing times. It has been four weeks, but it appears a workable solution was found. Wyatt was able to hold his blood sugar above 70 for over 48 hours. He is gaining weight on breast milk alone, but we will need to check his blood sugars at least four times daily. Immediately after discharge, we went to his first pediatrician appointment. He now weighs 4 pounds, 12 ounces, an impressive gain, yet still far below the growth curve. His brother, on the other hand, now weighs 7 pounds, 14 ounces. He gained a full pound in a week. We are hoping that having Wyatt home will produce the same results. On the downside, we just discovered today that he has an inguinal hernia as well as an umbilical hernia we were already aware of. We have been referred to a pediatric surgeon to see if these are things that need to be operated on immediately.
A Little Mix-Up. On the way to the NICU to discharge Wyatt, I missed a call and got a message. It went a little like this. "Hi, this so-and-so from the, what sounded like the, 'Drool Hospital.'" The next lines were the most odd, as we were thinking it was the NICU calling. The person on the other line said, "we have you circular saw ready for pick up." Huh? Was this code. Apparently, I had forgotten that I sent a saw to the "Tool Hospital" to be fixed because I had cut the power cord. I have not been very mentally sharp the last few weeks.
Wednesday, June 20, 2007
Alright, we are back and more diligent. The natives seems to be getting restless for more information. We apologize again for the lag.
First, I will give an update on the boys weights. They are now 5 weeks old. Gestationally, they would only be 38 weeks, 4 days. Randi just got back from the ICN and updated me that Wyatt is now 4 pounds, 2 ounces. He is definitely big enough to checkout of the Intensive Care Hilton. We just need to get his blood sugars regulated for a sustained period of time. Parks weighs 6 pounds, 14 ounces. He gained a pound in only 12 days. Very impressive!! So, Wyatt is closing the gap, but it was a very large gap to begin with.
We are trying to keep Parks on a 3 hour feeding schedule day and night since this is what Wyatt is going to be on when he comes home. Although we could probably stretch out Parks's feeds a little at night, Wyatt will not be able to do this with his blood sugar problems. We will be required to wake him every 3 hours to eat. We are starting to find a "groove" with night feedings to where I stay awake for the midnight feed. Randi gets the 3 am and also the 6 am feed which is when I am getting up and ready for work. Parks has also been doing pretty well at sleeping in between feeds, although with some grunting noises that wake Randi up. At this point, I do not feel that we are getting any more quantity or quality of sleep; I feel that we are just getting used to being sleep deprived...and I love sleep.
Most of my family came down for a couple days this week and left my mother to stay with us to help out. Randi really appreciates having someone else around during the days. Hopefully, I will convince Randi to pen a post about Wyatt's situation. She has taken more of the point on this while I stay at home with Parks during the evenings.
Monday, June 18, 2007
Friday, June 15, 2007
Well, it seems after over two weeks of Wyatt's roller coaster blood sugars that we might finally know what's causing the problems. I apologize we haven't posted more. Things have been crazy with Parks at home and Wyatt in the hospital, and I was hesitating to post about Wyatt's condition because I was having trouble understanding it myself. It seems that he is having some adrenal insufficiency in that his adrenal glands are not producing adequate amounts of cortisol, one of the stress hormones. The simplest explanation I could find is as follows..."Cortisol is a potent hormone known as a glucocorticoid that affects the metabolism of carbohydrates, proteins, and fats, but especially glucose. Cortisol increases blood sugar levels by stimulating the release of glucose from glucose stores in cells. It also acts to inhibit insulin, thus affecting glucose transport into cells." The important thing here is the role cortisol plays in regulating blood glucose. This is where Wyatt is having trouble. Now that we finally understand that this is the problem the endocrinologist has decided to administer a maintenance dose of steroids (cortisone) to replace what Wyatt is lacking. This should allow for better regulation of his blood sugars and hopefully prevent him from having anymore hypoglycemic episodes. He will come home on this medication and probably with a blood sugar monitor so we can check his glucose levels several times daily. Our prayer is that he will grow out of this and we can slowly taper him off of this medication.
Monday, June 11, 2007
In lieu of an update at this point, I have some pictures from the last week to share with everyone.
Friday, June 8, 2007
Regarding the endocrinologist.
After the post yesterday, they increased Wyatt's IV fluid rate in order to stabilize him before he saw the pediatric endocrinologist. When the endo did get a chance to see him, his blood sugar levels were in the 70's, well above the minimum of 50 they like to see. He ordered a whole series of blood tests that they did not draw blood for yesterday, and here's the kicker, we could not draw the blood for the tests until his glucose levels fell back down below 45. So, basically, we had to make him sick before we could make him better.
Well, sure enough, when we arrived last night to the hospital, his blood sugars had fallen again to 42 because they decreased his IV dextrose rate. Our whole visit was watching them take almost 10 ml of blood from our 3 pound baby for these tests. Also, some of the tests that they were drawing for are send off tests, which means that they will not be back until Monday at the earliest. The nurse that was attending Wyatt last night has had him previously during all this and pushed to increase his IV rate back up to gte him stable again. Hopefully, no one will touch the IV pump again until we get these tests back and have a real plan.
Sorry, the title is a really bad quote from the movie "Friday". It's all I can think about when someone refers to an endocrinologist as an "endo".
Thursday, June 7, 2007
We apologize that it's been close to a week since our last post, but we have been semi-conscious for most of it. Parks has been home a full week, and we are still trying to figure everything out. What works well for him and what doesn't work so well for him. It's like trying to feel out a new roommate back in my single days. What their schedule is, where they like to put things, what pushes their buttons to get them upset. Of course, there are some things that our children need that I never had to do for any other roommates, such as wiping their behinds, having them urinate on me, all night feedings, literally carrying them on my back. We have had our bumps in the road, but are surviving. Parks is growing well and is 18 inches long, weighing 5 pounds 14 ounces. He had his "minor" surgery today, and it appears to have gone very well, although I have not inspected the area yet.
Until last night Wyatt had been holding steady most of the week with no news to report as they decreased his IV dextrose and increased his breast milk. He was almost to the point of discontinuing his IV completely and graduating to bottle feeds until his blood sugar levels started to dip dangerously low again. He has really been on a roller coaster over the last week with this. His blood glucose levels were anywhere from 31 to121 throughout the night. Randi met with the neonatologist this afternoon, and we have finally said enough is enough. We requested they call in a pediatric endocrinologist who specializes in these matters. He is scheduled to see Wyatt this evening, and Randi and I are heading to the hospital later to see what was determined. They are running all sorts of blood tests in anticipation of what he might want, but we thought that at this time the ICN did not have a very clear idea of how to treat him properly. Hopefully, a fresh set of eyes will shed some light on the matter, so that we can progress in his treatment and get him home. Please, pray that some level of control will be regained in this situation and that nothing serious is wrong. We'll keep you posted.
Saturday, June 2, 2007
Spoiler Alert: The Tortoise Wins The Race
We have been preaching since day one to the ICN that they need to take it slow with Wyatt since he was an asymmetrically growth restricted baby whose heart and brain received the majority of blood in utero in order to sustain vital functions. Thus, his other organs and system were stunted in growth and development. I believe they are finally catching on. We called a few times last night to get updates whenever they would do a heel stick to check his glucose levels. Over the night he was able to hold his blood sugar levels just above an acceptable range. Again, this morning we called a couple times, and he started getting back to the type of numbers that were more normal. The doctor gave orders to increase Wyatt's breast milk and decrease his IV fluids again but at a much lower rate. While Randi and I were at the there tonight, the nurse checked his glucose again, and he appeared to be responding well.
Over the next 4 days, they will decrease his IV fluids and increase his feeds to make sure that he is, at least, getting the same amount of overall intake into his system, using a formula determined by his body weight. After that, they should hold everything steady for a day or two to see how well he tolerates continuous feeds without the IV before trying to wean him off of them. Next, they will try to him on continuous feeds for 2 hours and off for one hour, persistently checking his glucose levels. If he remains stable they will then have him on continuous feeds for one hour and off for two hours, until they titrate him off continuous feeds completely. The ultimate goal is to get him accustomed to 3 hour feeds, so they can introduce the bottle. This is all assuming that the doctor doesn't get a wild hair and do something drastic again. It is understandable to see him having such progress for how small he is and want to try to push him a little harder, but we feel that the grade on this slope needs to be very gradual.
UPDATE: Since I drafted this post last night, Randi called the ICN in the wee hours of the morning to check on his latest blood glucose level. They were 81, the highest they have been in days. As the recommended schedule has been presented, they will decrease his IV fluid rate today before noon and check him again for stability. We are going up there a couple times today as a tag-team to check on him, and we should have another update tonight.
Parks went to his first pediatrician checkup today. He is now 5 pounds 12 ounces at 18 days old. The doctor said that it is ideal to have the babies at least back to their birth weight by their first checkup, and he is 10 ounces over that. She gave him a thorough checkup and said that everything looked great. Since he was breach in utero, she wanted to check him out for hip dysplacia, but she could find no cause for concern after examination. On Monday, we will be setting up his "little surgery" for very soon. Randi is not sure she want to see it, but we were reassured that they will use lidocaine prior to help with the pain. After that, he will return to her for a 2 month checkup for growth and his first round of immunization shots.
At home, he is doing spectacular. He is nursing every three hours, the same schedule that he had in the ICN, and is sleeping great in between feeds. He sleeps, he eats, he poops. We have tried out the car seat, pack 'n play, co-sleeper, bouncy seat, baby swing, changing pads, white noise machine, etc., etc., etc. I really could care less to have all this stuff, but I will absolutely use every last bit of equipment we have just to justify having it. Randi can have the infant paraphernalia; I'm ready for the sports equipment and action figures, as I was promised (tongue-in-cheek).
Friday, June 1, 2007
Well, I had hoped to update with all good news as I visited this NICU between 11 am - 1 pm and things seemed to be looking better. His blood glucose had normalized for two separate readings, one at around 10 am and another one right before I left at 12:30 pm. However, Todd and I went together this evening and found out the doctor had ordered his IV fluids be lowered and within an hour Wyatt's blood glucose levels were 44. Just so you know, they like them absolutely no lower than 50, but 60 is really as low as he should be. So, they raised the IV rate and when we were there his sugars were 77. Not too bad, but we are a bit confused why they keep pushing this child. He is clearly not ready to be off the IV. Unfortunately, his doctor is gone for the day, so I will have to call in the morning and see if he's going to be there then.
Without sharing too much detail, I have also learned that Wyatt was possibly not receiving the most prudent of care from his doctors last night when all of this got really ugly. Basically, it took them almost 30 hours to stabilize his blood sugar and he was having dips as low as 26. Sugars that low are extremely dangerous! Todd and I are very disappointed and very worried and are trying to figure out the best way to handle the situation. Please keep Wyatt in your prayers and also his caregivers, that they make the best decisions for his health and that they allow him to move at his own pace instead of pushing him harder than his fragile body can handle. Thanks so much!!
Things are going well here at home. Parks did great his first night at home; however, I still didn't get much sleep. Todd was planning to be at home with us for a few days, but ended up having to go to work, so I'm on my own for most of today. We'll see how it goes.
Todd mentioned in his post last night that we had some problems with Wyatt's blood sugar yesterday. Without going into too much detail, they are having an extremely hard time stabilizing Wyatt's blood sugar levels. His blood sugar levels have been dipping to dangerously low levels since yesterday morning, but it appears to have gotten even worse throughout the evening and early morning hours. His 24 hour continuous feeds were discontinued yesterday AM along with his IV dextrose and electrolytes. The only thing we can figure is this was too much for his little system to handle at once. They have been giving him IV fluids all through the night and have also put him back on continuous feeds and they still cannot get his blood sugar up to normal levels. It seems the neonatologists are baffled. They will round on him again the morning, hopefully in the next hour or so. Fortunately, all the doctors are in today so hopefully putting all their heads together they will figure out what's going on. In the meantime, they have moved Wyatt to triage where he can have a nurse that can give him more attention so that is good.
The worst part about this of course is that I have Parks, and I can't bring him to the NICU. That coupled with the fact that Todd has to work today, is making for a very neurotic mother this morning. Just now a friend called and is coming so I can get to the NICU and see what's really going on. Please keep Wyatt in your prayers!! I will keep you posted.
We've got one down and one to go. Randi was very shocked today when she went to visit the boys to find out that Parks was being discharged today. We knew it was coming soon, but no one would give us a clear answer as to when it might transpire. So, as you can guess, today has been a bit of a mad dash to get everything "sort a" ready for his arrival. We got him home a little while ago, and Randi is nursing him for the first time here right now. Dante is not quite sure what to make of him, but all his fears and anxieties were quailed when he was offered a rawhide.
I am leaving you with a few pictures from tonight's departure. We have some more to tell about the discharge procedures details. We also had a scare early yesterday morning with Wyatt's blood sugar, but I am far too tired and not in the right frame of mind to go on. I'm surprised I'm this coherent. So, I will leave you with said pictures and go enjoy my new human being that I now own. We will hash out the other stories at some point tomorrow.